Application Research To The Stratification Of Patients In The Emergency Department With Physiologic Scoring Systems And Lactate Level

ObjectiveIn order to solve the emergency crowded, efficient use of emergency medical resources rationally, and early detection of assessment of critically ill patients, this study adopts the clinical observation research methods, simple random sample of emergency patients, respectively, for the five score (MEWS, ViEWS and ViEWS-L, MEDS, REMS), using lactic acid dry slice method for rapid detection of arterial blood lactate values, the statistical analysis of the distribution of the five score whether can well reflect the illness severity, further determine treatment intensity and hierarchical management to guide the emergency department, and predict the risk of death; To explore the lactic acid and ViEWS in the ViEWS-L score mortality prediction in patients with critical value.Methods1. Selected from August2012to January2013emergency department were the age of not less than18adult medical patient316cases,141cases of male, female175cases, excluding family members give up treatment, poor compliance and imperfect project of clinical data. Clinic after monitoring including temperature, pulse, breathing rate, blood pressure, peripheral oxygen saturation and consciousness to a total of six physiological indexes, ask medical history and living situation, laboratory examination of blood routine and rapid determination of blood lactic acid (admitting EICU),and on the basis of the five criteria scores respectively, records of patients with primary diagnosis and outcome (including complete departure from the hospital treatment, observation, admitting EICU, mortality of7days, the registration form for data analysis.2. The VITROS lactate dry slice method determination of arterial blood lactic acid.3. Epidata3.1software is adopted to establish the database model input data, using SPSS18.0statistical software for analysis.Result1. The clinical data of316cases of age admitted in our hospital emergency department not less than18adult medical patients in141cases of male, female175cases, aged18to92years old, average (45.01±21.88). Among them,159cases of observation,105cases of departure from the hospital after treatment,52cases admitted EICU (including9cases died)2. The survival group and death group based on age, sex, disease, five grades of the comparison results:two groups of patients in age, lactic acid content, the five ratings and diabetes, and hypertension on significant difference (P<0.05).3. The correlation analysis of five score:five grade two are very strong positive correlation between the two scorings, of which the MEWS and strongest correlation between ViEWS, correlation coefficient r=0.915, P<0.001, followed by the ViEWS and ViEWS-L phase relation r=0.907, P<0.001).4. The predicted effect of five score:5indicators reflect specific degrees of magnitude and the sensitivity of the area under the ROC curve for MEWS (the gold standard)> ViEWS> ViEWS-L> REMS> MEDS. In addition to a little less than gold standard MEWS area under the curve is0.982, ViEWS and ViEWS-L area under the curve were0.967and0.944, better sensitivity and specificity compared with the other two.5. Age, pulse and body temperature, blood pressure, breathing rate, oxygen saturation, GCS, the value of a single factor to predict mortality:according to the selection of data sample multi-factor binary logistic regression model is established, and evaluate these for seven days and death risk, according to eight factors, six factors in predicting dead end of7days there were no significant independent risk, and elevated blood lactic acid content (OR=1.380,95%CI:1.086～1.754) and the pulse (OR=3.541,95%CI:1.185～10.582) and increased risk of death is7days.6. Lactic acid levels and the relationship between the ViEWS:based on the data of52patients draw a scatter diagram shows that two variables are covariant relationship, simple correlation analysis to further known ViEWS score and lactate level was significantly positive correlation, the correlation coefficient of r=0.587, P <0.001).7. Five score’s the value of emergency department patients stratified respectively in patients:Four score score, the higher the outcome worse outcome, and the higher the score for the treatment of strength increase (departure from the hospital-under observation-EICU-death). As a result, can be presumed to four ratings for emergency patients stratified meaningful.Conclusion1.MEWS in recognition of critically ill patients have gained recognition and monitoring of disease progression, but did not prove in the internal emergency patients can improve medical adverse outcomes; ViEWS on the basis of MEWS introduced SPO2, thus improve the specificity of the MEWS; Add the lactic acid level ViEWS and form ViEWS-L score the short-term mortality in critically ill patients have significant predictive value.2. It is concluded that this study lactate, pulse and GCS is predicted mortality independent risk factors for7days.3. With the increase of patients with lactate value, an even higher ViEWS score7days increased mortality, statistical analysis it is concluded that the lactate level and ViEWS show significant positive correlation. To the introduction of the lactate scoring system can improve the specificity of the original score, improve the predictive value.